Doctor Curmudgeon: Doctors Yes! Providers No!

I am beginning to hate many words beginning with “P”. This may become my least favorite letter of the alphabet.

Among the exceptions to Doctor Curmudgeon’s P hate list are Physician and Parfaits (preferably chocolate)

Just look at these:

P- Pimple

P-Provocateur

P-Parsimonious (when it’s stingy, not frugal)

P-Plagiarize

P- PROVIDER

And, please refrain from peppering your pithy comments with all the good P words out there, let’s just focus on Provider.

I AM NOT A PROVIDER.

I did not receive a degree in providing. A provider is someone who makes things available, or makes arrangements or supports…or stuff like that.

I am proud to have earned an M.D. Doctor of Medicine.

Others are equally proud to have earned a D.O. Doctor of Osteopathic Medicine.

And so we are Doctors. We are Physicians. We are M.Ds and D.Os. We are not Providers.

We know that calling us providers is a way of lumping us with others … making us all the same. Just a bunch of providers.

I have my own little private insurgency going.

When I am on the phone calling in a prescription and, if asked for the “provider’s name,” I say, loudly and clearly, “I am NOT a provider. I am a physician. I am Doctor Curmudgeon.”

When some stupid form (by definition, all forms are stupid, to me) asks for the provider’s signature, I cross it out and write “physician” or “doctor,” depending on my mood.

I do not recall when first I heard the dreaded term “provider” – but I do not like it.

I survived medical school

I survived my training

I am now joyously practicing as a doctor

Bio:

Doctor Curmudgeon is Diane Batshaw Eisman MD, FAAFP, a Family Physician, writer, voiceover artist, and medical educator. It was in the Neolithic Era that the doctor became renowned for expertise in Trephination. After so much time in practice, Doctor Curmudgeon is now cranky and has rightfully earned the honorific of “Curmudgeon.”

Doctor Curmudgeon has no idea of what will appear in this space. It depends on the Good Doctor’s mood and whatever shamans and doctors are channeled at the moment.

As a curmudgeon, I may stray from what I observe happening in medicine and slink into other areas. But that is the prerogative of a Curmudgeon

For over 25 years, AFP has had a policy of prohibiting the use of the term “provider” when referring to physicians. Parenthetically, I find it surprising how many of my physician colleagues have adopted the term when referring to themselves. I doubt that neurosurgeons refer to themselves as “providers.” Why do we?—
I tell the students I teach at Georgetown School of Medicine: “You didn’t go to Provider School; don’t call yourselves providers!”
Jay Siwek, MD.
Editor, AFP

Sounds like the last gasp of the luddites yearning for the long lost “profession” that has lost its moral compass and sold out for cash.. Guess what you are a health care provider..

You are part of a team and the health care system would come to a stop without your nurses. Did you know that 80% of all primary care visits are either unnecessary or can be handled by a nurse? We know what happened when you were a doctor – 100,000 deaths a year, the highest costs in the world, doc’s who refuse to take medicare/medicaid (even though that is who paid for you to become a doc through residency and internship at 100k a year).. Perhaps you are neither now that I think of it?
(written with sarcasm to generate conversation)

I don’t think any doctor would disagree that nurses and mid-levels are needed in healthcare. And yes, it needs to be a team taking care of patients. Nurses are no less important than doctors. But, they are not the same. Doctors have many more years of training and more knowledge. You cannot attain the same amount of knowledge in less years.
To lump doctors and mid-levels as the same is inaccurate and a gross negligence to patients who may not know the difference.
Medicaid/medicare did not pay me or another doctor 1 cent to do residency. This was paid to the hospital who in turn paid us minimal salaries for WORK that we were doing for the hospital, often being on-call every 3-4 nights and not able to leave the hospital. I see medicaid pts but I often lose money treating them because the reimbursement is so low. Why are doctors expected to pay to treat patients? No other profession is expected to pay to work. And most doctors do much work for free, answering phone calls, being on call 24/7…we don’t get paid for that. We do it to provide care to our patients.
There is no data out there regarding the cost of mid-level mistakes. The population is getting older and suffering more complicated diseases. More adverse outcomes are going to occur just based on statistics.
And no, 80% of visits to my office are unnecessary or could be provided by a nurse. That is just blind conjecture. Any patient that walks through my doors, gets treated. With respect and a high level of medical care, regardless of their ability to pay.
I know most doctors feel the same as I do.
And talk about being a team, you are trying to behead doctors off of the team. Every player is important, we just have different roles to play. The doctor should be the lead, because like any team, the one with the most skills should take charge.

I congratulate you, Doctor Curmudgeon, for your PERSISTENCE, PERSERVERANCE, and PERTINACITY —- [yes I know they are all P words but obviously not on your "P Hate List"] — in trying to stamp-out the ugliness and inappropriateness of the use of the word PROVIDER when that word is erroneously associated with a Doctor of Medicine or a Doctor of Osteopathic Medicine.

I am certain that your “own little private insurgency…” shall prove to be the sine qua non of your ultimate success in eliminating that word PROVIDER from anything that is associated with “who or what” an M.D or a D.O “is or does.”

Thank you once again Diane for sticking to your guns and telling it like it is. Of course, I agree with you and am a physician, not a provider. While I do provide care to my patients, my training and experience is heads above the other members of any team. We earned our stripes and should wear them proudly, not diminishing the contributions of others in the healthcare industry at all, just being proud of our earned credentials. The term provider is no accident and has crept into the vernacular as a result of the insidious influence of third party payers in health care. Keep up the excellent commentary!!!

This is a wonderful presentation of an ongoing problem. The term “provider” grates on most physician’s ears. I wrote a small rant about this several years ago:
I’m a Doctor, Not a “Provider”
“As a physician, I am concerned that the American public may be putting their trust in someone with only three or four years of training, but definitely less than a physician. Who gets called when there is a problem? The physician gets a phone call or emergency page when things are beyond what the midlevel can handle. If it was me or my family member, I would be quite upset at this point. The physician does not know you and your history. You are meeting someone who may be making life altering decisions for the very first time. When I have a choice, I prefer to be seeing a physician who knows me or my family and speaks the language of the other physicians that will be providing my emergency care.”http://voices.yahoo.com/im-doctor-not-provider-6489902.html?cat=5
Nothing has changed.

By virtue of 4 years of college, 4 years of medical school and 3 years of residency – I AM A DOCTOR! I’m proud of it, I expect it (in professional settings). If certain people with delicate sensibilities object to us doctors expecting or demanding to be addressed and RECOGNIZED as such – too bad. YOU can call yourself a provider if you so desire, but don’t expect me to do the same. Thank you.

Thank you for re-introducing to the public the difference. It is not because of arrogance or wealth that there is a difference, it is education, dedication and risk that separate physicians from those who want to call everyone a provider. Nurse practitioners and physician assistants want independent practice and try to claim equality to physicians but they cannot, they are only good with being 9 to 4 employees and not sharing the financial or legal risks – falling back on physicians to take the risks when things go bad. The plain Jane nurses despises physicians and also claim knowledge equality, but we know that is a false claim based on just their inability to complete a full sentence. This insanity IS caused by government influenced officials bought by the tens of millions of dollars paid by insurance companies, hospital corporations and Nursing organizations to increase profits and raise a less than educated semi-professional group to equality parity with physicians. It has nothing to do with improved medical quality (as not defined by the government), but increasing the pay to so-called physician extenders and insurance/hospital complex. Wonderful blog.

The term Provider dehumanizes who ever provides the service. It impacts the genuine connection~rapport between patient, physician and respectable non-physician clinicians. It impacts the compliance and treatment outcomes.

Provider is a mechanical term used to lump everyone and create false sense of “Equality”.

Inclusiveness doesn’t mean the patients has to be “conned”.

Yes for Team work, No for dehumanizing Physician and others.

My objection to provider is not based on respect but based on basic human courtest, behaviors. We are all human beings first and then physician or NP/PAs.

Provider; today’s government and young generation to gender neutral, to not having to take a position of fear of being wrong or offend anyone. It’s represents today’s leaders and followers who have No balls and NO opinion unless it was fed to them by someone else, probably a politician or the web…

A physician told me that his daughter, took her residency in medicine, took a fellowship in cardiology, and is now taking a FOUR year fellowship in congenital cardiology. If somebody calls her a provider, I am sure she will kill. No jury will convict her.

@Roberta: A DNP is not an MD is not a physician. We need to make a distinction. I am a strong advocate of patients being advocates for themselves and making their own healthcare decisions. But, how can they make informed decisions in choosing who they want to treat them when the distinctions are blurred? I believe DNPs should be recognized by their credentials. But, patients should be empowered to make fully informed choices and there needs to be transparency there. I feel no shame in wishing this on my patients. And I have no problem if a patient rather see a DNP than me. I just want them to know who they are seeing.

Waying in as a psychotherapist, I also agree. We are losing our identities by being lumped together as “providers”. And it also minimizes are individual training. And we seem to go along with this like driven cattle. Keep up the good work!!! Keep it coming!

A friend called who was at her dentist’s office and when she was making her appointment, the receptionist asked, “Which provider do you see?”
She shrieked that she wanted to see a Dentist, not a provider

It seems a bit hypocritical on the part of the national healthcare behemoth–on the one hand they discourage the holistic, old-style family doctor way of practicing and move in favor of fragmented healthcare. On the other hand, they lump everyone together as “provider” and in so doing, they mask the specialization they encourage through their other actions.

When I purchase a tangible object, it is from a merchant who is a provider. Food is put on one’s family’s table by a provider. A medical doctor is an artist and a person of science. I agree that to use an insurance industry term “PROVIDER” is an insult to all who have worked so hard for their degrees and their profession.

Albert Einstein said, “Never stop questioning”. As a continuing medical education professional I provide CME specifically to thousands of doctors seeking to maintain their licenses. I’ve watched physicians work tirelessly to increase their knowledge and skills. At times I would question to what end? Why work longer hours for seemingly less pay every year? Why battle the bureaucratic behemoths in the health care system? Why risk your life to save another infected with a dangerous contagion?

The father of modern medicine physician William Osler answers these questions best. He said, “The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.”

Dr. Eisman keep writing your brilliantly blithe blog with that sardonic twist! We all need the salve of laughter it offers.

Hear! Hear! Dr. C. Hey, I may even out-curmudgeon you, as I bristle a bit at being called “doc.” (Is that abnormal?) But I’ll take “doc” over “provider” any day. BTW, the Amer. Acad. of Ophth. has had a campaign for several years to use the term EyeMD to help people distinguish from other eye care “providers” such as optometrists. As others have stated, we must remain vigilant and discourage the use of any terms the corporate or gov’t shills use to cheapen our credentials. Thanks for the post.

Great points Diane.
Like you and many here, I spent 4 years in medical school to obtain my MD. I then did 5 years of general surgery, and additional residencies in Cardiovascular surgery, Vascular Surgery, and a Congenital Cardiac Surgery Fellowship. I provide for my family and I provide care for my patients, but it is a much higher level of care than is “provided” by providers with 2-4 years of “medical” training in nursing or PA school.

Colleague and Forrest, thank you.
We will keep up the good fight.
When I call in a prescription, and the irritating voice mail asks for the Provider’s name, I loudly proclaim, “I am NOT a provider. I am a physician. I am Doctor Curmudgeon.”

It is sad that physicians, with all their years of education and training, are being erroneously described as “providers”. Where physicians do provide care to their patients…..that care is above and beyond what one would expect from a “provider”. It is like comparing a licensed attorney with a certified paralegal. Would you like a paralegal to negotiate your divorce or make sure the title liens on the property you are purchasing are properly cleared? I think not! Keep up the good work in spreading the message……physicians are well educated and trained individuals who should not be grouped together with medical personnel who have limited education and training……Physicians are not providers.

I love Dr. Curmudgeon…let me count the ways:
1. Caring & dedication to patients
2. Expressing so succinctly the irritation we all experience with “the healthcare system” (another misnomer!)
3. Being spot on about the idiocy of the”healthcare non-system”
4. Helping me laugh when I feel very cynical about how the “non system”
always seems to be interfering with true caring for patients
5. And very importantly understanding the role of chocolate in coping with it all!
Thanks, Dr. C!

Thank you for your comment, Withuf.
Physicians do not like PAs. They have nowhere near the training that we have and can miss something important.

We all make mistakes, but PAs just do not have the education, experience and many times, just do not have the ability to “know what they do not know,” and therefore ask for help or refer to a specialist.

Your physician may have a PA. We do NOT. My feeling is that if a physician is that busy, he can hire another MD or DO:, even part time.

I do not know what is more important in my practice than my patients and I want to see them .

Many physicians feel that provider lumps us together with ancillary people. An MD or DO is a physician . Period.

Physician’s don’t like PAs? Sure they do: When they’re helping to reduce their workload or doing things the physicians don’t want to do themselves. Physician’s just don’t like to be lumped in with PAs or with nurses or NPs.

Another term I find creepy is “mid-levels”. Mid-level of what? Does that make MDs “high level” and RNs “low level”?

In the academic setting, I used to be annoyed by the term “clinician” (instead of physician) which was used to distinguish PhD research faculty from MD medical faculty.

To me the term “provider ” supports and encourages Doctors to feel okay about not taking the time to connect to their patients. The state of the current healthcare system is weighted down by excess processes, paperwork and politics…..which in some cases leads Doctors further down the path to be “providers” to their patients…..I am blessed that my Doctor knows my name and history without being reminded. She calls me personally to update me on any test results, check on me and more. She has given me her cell number to call anytime I need. She takes time to answer any questions. I consider her a very special blessing in my life! Thank you for being such an exceptional , compassionate , honest, and caring Doctor !
Deborah S.